Medically ready for discharge: A multicenter Veterans Health Administration assessment of hospitalized patients.

Abstract

Background: Patients may remain hospitalized despite being medically ready for discharge, some for prolonged periods. Delays in discharge may negatively impact patients and hospitals.

Objective: To quantify the proportion of acute care general medicine patients in VHA hospitals who are medically ready for discharge but remain hospitalized due to major discharge barriers and to identify the major contributors.

Methods: Cross-sectional study of 21 VHA hospitals using a structured tool to collect data from inpatient medicine attending physicians about their patients and the hospital on a single day. Primary outcomes were the percentage of patients medically ready for discharge and those with "major discharge barriers" (medically ready for discharge ≥1 week). Secondary outcomes explored support needs, resources awaited, and major contributing factors.

Results: Of 1,348 sampled patients, 41.9% (n = 565, range 18.4%-64.7%) were medically ready for discharge, including 18.1% (n = 244, range 0%-32%) who had major discharge barriers. For more than half of these patients, the intended discharge location was a long-term care facility (41.9%, nursing home for custodial care; 9.7%, assisted living facility). The most identified support needs were assistance with ADLs and geriatric-psychiatric care. Payor source and selection of discharge location were the most common resources awaited.

Conclusions: Nearly one in five hospitalized veterans had major discharge barriers leading to prolonged hospitalization after they were medically ready for discharge. More than half were awaiting long-term care placement. This was due to a lack of available post-discharge resources and support. Multidisciplinary engagement to streamline processes and increase resources for post-discharge facility placement is needed.